Hour11 Flashcards

1
Q

Spina Bifida

A

tuft of hair o dimple where buttcheeks separate
skin is closed

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2
Q

Meningocele

A

bulge meninges sac of CSF with no nerve involvement no paralysis

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3
Q

Myelomeningoclele

A

protrusion of meninges with CSF + nerves
-more likely to have bowel problems, paralysis + weakness
-Increased concern for infections

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4
Q

Screening for spina bifida + Detection

A

16 to 18 weeks/ Alpha fetoprotein test

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5
Q

Repair for Spina

A

48-72hrs

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6
Q

Nursing Care for spina

A

PROTECT TISUES WITH STERILE MOIST DRESSING+ OCCLUSIVE.
Postiion child prone off defect

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7
Q

Kidney rt spina

A

urinary catheter to prevent infect
Crede Bladder
suprapubic so that you aren’t positiong the child on their defect to re cath often

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8
Q

Neurological rt Post op spina

A

Check finger+ toes, rooting
Chek ICP
VP shunt: drains out the fluid and decrease ICP
Hydrocephalus: pressure cause brain/skull seen in myelomeningcole pts look for ICP increased, blocked shunt, leaking CSF, head circumference

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9
Q

Hydrocephalus ( define/ s+s)

A

increased fluid in ventricles they route CSF in brain.causing the ventricles to enlarge which puts pressure on the brain tissue resulting in brain damage

s/s = head circumference
Bulging Fontanels
irritability, high pitched cry, nuchal rigidity
vomiting
feeding difficulties
increased frontal lobe
plate scratching sound
transillumination = increased red in head
sunset sign= eyes appear downward ; white of eye visible
prominent veins

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10
Q

Childhood(4) vs Infancy (10) Hydrocephlaus s/s

A

Infancy: skull veins, increased ICP, cry, irritable, increased head circumference, bludging anterior fontalles, cracked pot sound
transillumination = increased red in head
sunset eyes - eyes deviate downward

Childhood
Focal manifestation
Headache
Irritable
Confused

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11
Q

Tx of hydro

A

a shunt is inserted to drain into peritonea cavity
mointo for chnage in neurlogical status

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12
Q

Post op VP SHUNT (6)

A

postion off shunt
continue assements for meningitis
ICP increased
Blocked shunt
Leaking CSF ( halo or glucose test) * what color should it be?*
Head Circumference

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13
Q

Cleft Lip

A

development of lip isnt developed in utero can see in ultrasound
can be complete (involvement nasal passage) or incomplete

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14
Q

Nurse/Delivery for cleft lip

A

keep neural face and reaction

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15
Q

Pre-op Care for cleft lip

A

support family
can breastfeed with adaptations to stimulate deeding and mom pumps
meet infant sucking need with pacificer usage during g tube
Feed upright
skin stretchers may inserted prior surgery to increase amount of skin available to graft to ne areas
Piegon bottles
BURP FREQUENTLY

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16
Q

Complications rt cleft lip (4)

A

Aspiration pneumonia
FTT
Decreased bonding
Infections (ear + respiratory)

17
Q

Post Op care rt cleft lip (7)

A

Positioning SUPINE ONLY

Logan Bow/bar = protect inscions - remove during feedings

Rinse mouth after feeding, incsion+ wound care
Arm restraints to prevent touching of site
HOB up (infant seat) help decrease swelling / propped on side
Feeding resumes when cleared
NO SPOONS ( requires movement of lips)
Prevent crying (bonds+ pain meds)

18
Q

Post-op complications rt cleft lip + plate (5)

A

Infection (ear+ lung dt opening)
Disruption of suture line
Speech problems
FTT
nutrition alterations

19
Q

Cleft Palate

A

Incomplete closure of palate @9 weeks gestation

20
Q

Surgical interventions (cleft palate)

A

Between 1-2 1/2
Before speech patterns

21
Q

Preop Cleft Palate (think about feeding)

A

BURP MORE FREQUENTLY
Retainer; special nipple for feeding
Long, soft nipples and bottles ( plastic or silicone spoon)
May use GT ensure adequate intake

22
Q

Post Op Cleft Palate

A

Oral care, protect site
Pain relief , no specially postion requirements
No-No ( restraints)
Games to develop speech/word
SOFT foods . careful with spoon

23
Q

Tracheoesophageal Fistula and Esophageal Atresia

A

TEF: abnormal connection between upper part of esophagus and trachea/windpipe
EA: when upper part of esophagus does not connect with lower esophagus/stomach

24
Q

S/s of TEA + EA

A

3 C’s = cough, choking, cyanosis with first feed
Frothy saliva in mouth _nose, drooling
Monitor first fed stop immediately notify MD
Respiratory Distress during feeding
Abdominal distention
Aspiration pneumonia
IVF, G tube

25
Pyloric Stenosis:
hypertrophy (enlargement of muscle around sphincter) and hyperplasia (enlargement of tissue) of pyloric sphincter decreases flow of food through pylorus from stomach to duodenum
26
S/S of Pyloric Stenosis
3wks: regurgitation of breast + formula -4-6wks: projectile vomiting in healthy infant (up to 3hrs after eating), no bile in vomit - May progress to malnutrition, metabolic alkalosis hypokalemia , dehydration (sunken fonatlle) , FTT ( nto retaining anything) - May feel olive sized firmness at pylorus Palpable right epigastric region ( hypertriphied pllorus ) - See waves of peristalsis across abdomen
27
Treatment Pyloric Stenosis (3)
Least invasive to first 1. thickened foods, elevated 30 minute after eating 2. Endosopcic dilation = ballon inserterd to expand opening 3. Laparoscopic plyrmyotomy : cuts muscle thru abdomen
28
Nurse Dej job POST OP rt Pyloric Stenosis (6)
-Fluid and electrolyte balance -Daily weights - Meet infant needs: bonding, pain relief - Oral feedings immediately after surgery (Breastfeed/formula) Clear liquids and advance as tolerated ( 1/2 strength then full stength ) - No pacifier, Burp well- decrease air intake
29
HT rt pyloric stenosis Post op
Vomiting is normal S/S dehydration , resuming BF/formula Infection HRF SEPSIS
30
Hirschsprung’s Disease:
lack of normal peristalsis due to absence of autonomic parasympathetic ganglion cells; No movement in bowels, leads to retention of stool, distention of bowels ( mechanical obstruction)
31
S/S rt Hirschsprung’s Disease (7) ## Footnote think about newborns for first s/s!
Distended abdomen Feeding intolerance Billious vomit ( key difference) Delay in passage of meconium Constipation Ribbon like stools Enterocoliits
32
Nursing Responsibilities: Hirschsprung’s Disease Post Op ## Footnote define
Removal of intestine+ Temporary colostomy. S+S of wound infection + bowel obstruction Appetite Abdomen Weight Colostomy ( red+pink)
33
Intussusception:
telescoping of a portion of the intestine into an adjacent portion; common at six months to 6 yrs compression on blood vessels leading to possible necrosis
34
Intussusception s/s (5)
sudden onset of abdominal cramp pain bilious vomiting tender distended abdomen at umblical area currant jelly stool ( purple color , dark red), mucousy LOOSE SCANT STOOLS
35
Tx of Intusssuscpetion
Liquid or air enema to "reopen intenstines" (ASAP) Surgical repair if doesnt work